PURPOSE: To investigate the effect of patient and tumor factors on the degree of tumor necrosis and the effect of the degree of the tumor necrosis on the survival in patients treated with curative resection following transcatheter arterial therapy. MATERIALS AND METHODS: 90 patients diagnosed as having hepatocellular carcinoma and treated with curative resection following transcatheter arterial therapy at Yonsei Medical Center between January 1986 and December 1995. The subjects were classified into four groups: 100% necrosis group (Group I, n=29), over 95% necrosis group (Group II, n=28), 50-95% necrosis group (Group III, n=13) and below 50% necrosis group (Group IV, n=20). The factors which affect on the necrosis of the tumor were compared. The overall and disease-free survival rates according to the degree of tumor necrosis were illustrated. RESULTS: There was no statistical difference in the degree of the tumor necrosis according to age, sex, HBsAg, g-FP, liver cirrhosis, tumor size and morphological classification. In the comparison between the preoperative transcatheter arterial therapies, however, transcatheter arterial chemo-oily embolization (TACOE), which used the injection of the mixture of 3 10 cc Lipiodol and 30-50 mg Adriamycin followed by Gelfoam em- bolization, showed the higher number of 100% necrosis and over 95% necrosis cases. The 1, 3 year overall survival rates were greater for Group I, although not statistically significant. The 1, 5 year disease-free survival rates were greater for Group I, although not statistically significant. CONCLUSION: In the preoperative transcatheter arterial embolization, TACOE was most effective to get total necrosis of tumor. However overall survival and disease free survival were not affected by the amount of tumor necrosis.
Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Doxorubicin ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatitis B Surface Antigens ; Humans ; Liver Cirrhosis ; Necrosis* ; Survival Rate

OBJECTIVE: The aim of this study is to describe the clinical characteristics and outcome of cancer diagnosed during pregnancy. METHODS: This is a retrospective cohort study of women who were diagnosed with cancer during pregnancy at a tertiary academic hospital between 1995 and 2013. Maternal characteristics, gestational age at diagnosis, and type, stage, symptoms and signs of cancer for each patient were retrieved from the medical records. The cancer treatment, pregnancy management and the subsequent perinatal and maternal outcomes for each cancer were assessed. RESULTS: A total of 87 women were diagnosed with cancer during pregnancy (172.6 cases per 100,000 deliveries). The most common cancer was breast cancer (n=20), followed by gastrointestinal (n=17), hematologic (n=13), thyroid (n=11), central nervous system (n=7), cervical (n=7), ovarian (n=5), lung (n=3), and other cancers (n=4). Eighteen (20.7%) patients terminated their pregnancies. In the 69 (79.3%) patients who maintained their pregnancies, one patient miscarried and 34 patients delivered preterm. Of the preterm babies, 24 (70.6%) were admitted to the neonatal intensive care unit and 3 (8.8%) of those expired. The maternal mortality rate was 31.0%, with highest rate seen with lung cancers (66.7%), followed by gastrointestinal (50.0%), central nervous system (50.0%), hematologic (30.8%), breast (25.0%), ovarian (20.0%) cervical (14.3%), and thyroid cancers (0%). CONCLUSION: The clinical characteristics and outcome of cancer during pregnancy were highly variable depending on the type of cancer. However, timely diagnosis and appropriate management of cancer during pregnancy may improve both maternal and neonatal outcome.
Breast ; Breast Neoplasms ; Central Nervous System ; Cohort Studies ; Diagnosis ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lung ; Lung Neoplasms ; Maternal Mortality ; Medical Records ; Pregnancy Outcome ; Pregnancy* ; Retrospective Studies ; Thyroid Gland

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.
Acyclovir ; Adult ; Child ; Cyclosporine ; Diagnosis ; Early Diagnosis ; Female ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunosuppression ; Incidence ; Korea ; Liver Transplantation* ; Liver* ; Logistic Models ; Lymphoma, B-Cell ; Lymphoproliferative Disorders* ; Male ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors ; Seoul ; Transplantation

OBJECTIVE:To evaluate the clinical usefulness of cytomegalovirus (CMV) antigenemia assay among liver transplant recipients in Samsung Medical Center. MATERIALS AND METHODS: All recipients of liver transplantation during the period from Jan. 1996 to Aug. 2003 were enrolled. Medical records and microbiologic data for CMV infections were reviewed retrospectively. RESULTS: All 284 enrolled patients received livers from CMV seropositive donors, and 272 recipients (95.8%) were CMV seropositive before transplantation. One hundred thirty three recipients (46.8%) had evidences of CMV reactivation. Among patients with CMV reactivation, 40 recipients were symptomatic (30.1%) and 12 patients had organ-specific CMV diseases. Most of the CMV infections occurred within 180 days after transplantation except for 9 patients (6.7%). Among the antigenemia positive patients, the mean number of CMV antigen-positive WBC was 19.36 per 200,000 cells (19.36+/-37.64 cells). The mean duration of CMV antigenemia was 8.72 days (8.72+/-9.99 days). Peak value of CMV antigenemia was significantly higher in symptomatic patients compared to asymptomatic patients (P=0.002). Duration of CMV antigenemia was significantly longer (P=0.002) in symptomatic patients. If we would use > or = 5 cells of CMV antigenemia as a cut-off value sensitivity and specificity for symptomatic CMV infections would be 85% and 50% respectively. CONCLUSION: About half of the recipients experienced CMV reactivation, mostly within 180 days after liver transplantation. Thirty percents of reactivation were symptomatic. Five cells per 200,000 leukocytes of CMV antigenemia was the best cut-off level for preemptive treatment.
Cytomegalovirus* ; Humans ; Leukocytes ; Liver Transplantation* ; Liver* ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Tissue Donors ; Transplantation

BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.
Acyclovir ; Adult ; Child ; Cyclosporine ; Diagnosis ; Early Diagnosis ; Female ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunosuppression ; Incidence ; Korea ; Liver Transplantation* ; Liver* ; Logistic Models ; Lymphoma, B-Cell ; Lymphoproliferative Disorders* ; Male ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors ; Seoul ; Transplantation

OBJECTIVE:To evaluate the clinical usefulness of cytomegalovirus (CMV) antigenemia assay among liver transplant recipients in Samsung Medical Center. MATERIALS AND METHODS: All recipients of liver transplantation during the period from Jan. 1996 to Aug. 2003 were enrolled. Medical records and microbiologic data for CMV infections were reviewed retrospectively. RESULTS: All 284 enrolled patients received livers from CMV seropositive donors, and 272 recipients (95.8%) were CMV seropositive before transplantation. One hundred thirty three recipients (46.8%) had evidences of CMV reactivation. Among patients with CMV reactivation, 40 recipients were symptomatic (30.1%) and 12 patients had organ-specific CMV diseases. Most of the CMV infections occurred within 180 days after transplantation except for 9 patients (6.7%). Among the antigenemia positive patients, the mean number of CMV antigen-positive WBC was 19.36 per 200,000 cells (19.36+/-37.64 cells). The mean duration of CMV antigenemia was 8.72 days (8.72+/-9.99 days). Peak value of CMV antigenemia was significantly higher in symptomatic patients compared to asymptomatic patients (P=0.002). Duration of CMV antigenemia was significantly longer (P=0.002) in symptomatic patients. If we would use > or = 5 cells of CMV antigenemia as a cut-off value sensitivity and specificity for symptomatic CMV infections would be 85% and 50% respectively. CONCLUSION: About half of the recipients experienced CMV reactivation, mostly within 180 days after liver transplantation. Thirty percents of reactivation were symptomatic. Five cells per 200,000 leukocytes of CMV antigenemia was the best cut-off level for preemptive treatment.
Cytomegalovirus* ; Humans ; Leukocytes ; Liver Transplantation* ; Liver* ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Tissue Donors ; Transplantation

PURPOSE: Paclitaxel has not been used widely in gastrointestinal cancers. However, a recent phase II report of paclitaxel in patients with esophageal adenocarcinoma has suggested a possible role of paclitaxel for the treatment of advanced gastric carcinoma. A phase II trial was initiated to determine the clinical utility of a 3 drug combination (paclitaxel, cisplatin, and 5-fluorouracil) in patients with advanced gastric carcinoma. MATERIALS AND METHODS: Eligibility included biopsy-proven inoperable or relapsed adenocarcinoma of the stomach with adequate bone marrow, hepatic, and renal function. Patients received paclitaxel at 175 mg/m2 (3 hour infusion) on day 1 followed by cisplatin at 20 mg/m2/day infusion and 5-fluorouracil at 750 mg/m2/day continuous infusion for 5 days. Treatment has been repeated in every 4 weeks. Total 31 patients were enrolled; 7 had relapsed disease after resection and 5-fluorouracil based adjuvant chemotherapy, 5 had previous chemotherapy. Twenty-one patients had measurable disease and 9 were evaluable. Demographics included; median age, 47 years (range, 27~64 years); male: female, 21: 10; median performance status 2 (range, 0~4). RESULTS: Major responses occurred in 16/30 (53%; 95% confidence interval, 35~71%) patients (2 complete responses, 14 partial responses); 13 of 21 (61.9%) patients with measurable disease and 3 of 9 (33%) evaluable patients. Median response duration was 17 weeks (range, 8~44+ weeks) and median time to progression was 20 weeks (range, 8~51+ weeks). Median survival was 27 weeks (range, 8~72+ weeks). WHO grade 3~4 toxicities included: neutropenia (61.9%), nausea/vomiting (23.8%), mucositis (19%), and diarrhea (9.5%). Grade 2~3 neurotoxicity, fluid retention syndrome, hypersensitive reaction had occurred in 6, 2, and 1 patients, respectively. There was 1 instance of treatment-related death due to sepsis. CONCLUSION: This regimen was highly active in advanced gastric carcinoma and had moderate toxicity. However, the response duration was short like other regimens. Considering poor performance status of our patients, this regimen may have strong potential in the neoadjuvant setting.
Adenocarcinoma ; Bone Marrow ; Chemotherapy, Adjuvant ; Cisplatin* ; Demography ; Diarrhea ; Drug Therapy* ; Female ; Fluorouracil ; Gastrointestinal Neoplasms ; Humans ; Male ; Mucositis ; Neutropenia ; Paclitaxel ; Sepsis ; Stomach Neoplasms* ; Stomach*

BACKGROUND AND OBJECTIVES: Antibiotic prophylaxis of infective endocarditis is required before high-risk procedures in patient with high-risk heart diseases. Although guidelines for the prevention of infective endocarditis were proposed by the American Heart Association in 1997, compliance to these recommendations has not been evaluated in Korea. SUBJECTS AND METHODS: This was a retrospective, multicentered study in 8 Korean university hospitals. Patients with high-risk heart diseases, having undergone invasive dental procedures between Jan. 1, 2000 and Dec. 31, 2003, were enrolled. The medical and dental records of the patients were reviewed to evaluate whether the prophylaxis had been appropriate. RESULTS: Of the initial 4,912 patients, 184 that had been treated with invasive dental procedures (255 total episodes, mean 1.4/patient) were evaluated. The most common high-risk heart disease was a prosthetic heart valve (233 procedures), followed by a previous history of infective endocarditis (22 procedures), cyanotic heart diseases (5 procedures) and systemic pulmonic venous shunts (2 procedures). Antibiotic prophylaxis was performed in 231 procedures (90.8%). Amoxicillin was the most common antibiotic used for prophylaxis (88.6%); however, the adequate dosage (2 gm) was administered in only 56% of these cases. Therefore, the appropriate prophylaxis, according to the AHA recommendations, was performed in only 14.1% (36 procedures). The mean duration of prophylaxis and number of antibiotic doses were 2.40 days (2.40+/-2.44) and 7.97 doses (7.97+/-7.18), respectively. A previous history of infective endocarditis (p=0.03) and dental extraction (p<0.01) resulted in a longer duration of prophylaxis. CONCLUSION: Only 14.1% of the high risk group procedures were given appropriate antibiotic prophylaxis according to the AHA recommendations. These data suggest that protocol-based education of both doctors and patients is required for appropriate antimicrobial therapy during high-risk procedures for the prevention of infective endocarditis in patients with high-risk heart disease.
American Heart Association ; Amoxicillin ; Antibiotic Prophylaxis ; Compliance ; Dental Records ; Education ; Endocarditis* ; Heart Diseases ; Heart Valves ; Hospitals, University ; Humans ; Korea ; Retrospective Studies